I am grateful to Dr Davies for highlighting the importance of faith and belief in psychiatry. Atheism, materialism and biological determinism are as much belief systems as are religions. Because of a mismatch between systems of belief, it will often be inappropriate for clinicians to pray with patients. But what about prayer in contexts where faith and belief are shared? In faith-based organisations, in faith communities and in other contexts where doctor and patient are brought together knowing that they share the same belief system, ‘praying with a patient’ takes on a different connotation. The psychiatrist who prays with a patient in such contexts should still be able to justify their reasons for thinking that this would be helpful, and their reasons for expecting that it would do no harm, but I do not see why it should automatically be excluded.

Pace Dr Haley, I do not view prayer as a therapeutic tool that ‘can exclude the history of Christianity in this country and the challenges this may pose’. In some parts of the UK, sectarianism is such that differences between some ‘Christian’ groups are greater than those between people from completely different faith traditions. Naive attempts to pray across these divides, in the clinical context, are ill advised. Haley describes my view of prayer as a means of ‘the individual’s connection to the Divine’. I limited prayer to being defined as ‘conversation with God’ only because this appeared to be the understanding of prayer that was causing concern. This approach to prayer is not associated preferentially with the Protestant or dissenting tradition, and is encountered in the writings of Catholic saints such as Ignatius Loyola and Teresa of Avila. The writings of Ignatius and Teresa, among others, now unite many Christians from different spiritual traditions (e.g. Catholic and Protestant).

The idea that spiritual and pharmacological treatments are analogous, and that they should be dealt with in completely separate departments, may have some attraction to Dr Haley. However, I am frequently approached by service users who find this kind of fragmentation of their care to be unhelpful and unacceptable. We do not accept separation of the psychological from other aspects of well-being. Similarly, I do not see why prayer should be excluded.

A position statement on spirituality and religion in psychiatry has recently been published by the College. ^{Reference Cook1} Although this statement does not explicitly address Dr Sarkar’s concerns about praying with patients, it provides guidance that should be very helpful in avoiding breaches of professional boundaries in clinical practice. I think that the situations in which praying with a patient represents as serious a breach of professional boundaries as preaching to a patient will usually be because they are just that – preaching (albeit under the pretext of prayer). I find this just as unacceptable as those situations encountered by service users who feel that they have been ‘preached at’ by their atheist psychiatrist.